Type 2 Diabetes Formative Case Study

Introduction

The nursing process is a structured method that directs nurses as they provide specialized patient care. It involves evaluation, planning, implementation, diagnosis, and assessment(Shewangizaw et al.,2015). This essay will describe how the nursing process was used in the treatment plan for Mike, a 56-year-old traffic cop with numerous comorbidities and poorly controlled type 2 diabetes.

Elevated blood glucose levels result from type 2 diabetes, a chronic metabolic condition that changes how the body uses glucose(Sanches et al.,2023). The Roper-Logan-Tierney model was selected as the evaluation framework for this care plan because it focuses on the patient’s activities of daily living (ADLs) and offers a thorough assessment of their functional abilities.

The first nursing diagnosis is ineffective self-management related to poor knowledge, unhealthy lifestyle practices, and noncompliance with the diabetes medication regimen. The patient’s poor comprehension of their disease and noncompliance with treatment, which resulted in poor glucose control and comorbidities, are related to the aetiology of this diagnosis. High HbA1c readings, higher blood glucose levels, and diabetes complications indicate this diagnosis. Interventions are tailored to individual needs.

The second nursing diagnosis is the risk for cardiovascular disease related to hypertension, dyslipidemia, central obesity, and unhealthy lifestyle practices. The aetiology of this diagnosis is related to the patient’s modifiable risk factors for cardiovascular disease, including hypertension, dyslipidemia, central obesity, and unhealthy lifestyle practices. The signs and symptoms of this diagnosis include elevated blood pressure, dyslipidemia, and central adiposity. Nursing goals include reducing cardiovascular risk, improving blood pressure and lipid levels, and promoting healthy lifestyle choices.

The Roper-Logan-Tierney model is used in this care plan’s assessment of the patient’s functional ability to create individualized nursing interventions that cater to each person’s requirements and preferences(Holland et al.,2019). Nursing diagnoses highlight the importance of education and counselling on lifestyle changes, medication adherence, and prevention strategies to improve the patient’s glycemic control and lower their risk of cardiovascular complications. Evidence-based recommendations support nursing interventions, and evaluation is done constantly.

Pathophysiology

High blood glucose levels are a hallmark of type 2 diabetes, a chronic metabolic condition caused by the body’s ineffective use of insulin. The hormone insulin controls blood glucose levels, and type 2 diabetes occurs when the body produces insufficient insulin or develops immunity to its effects. As a result, glucose accumulates in the blood, which over time, can harm many organs and systems( Sanches et al.,2023).

The polydipsia, polyuria, and polyphagia Mike exhibits point to uncontrolled hyperglycemia (Bottaro, 2021). He has polyuria because his blood glucose levels have exceeded the renal threshold and are being eliminated in his urine. Since his body is attempting to make up for the water lost due to polyuria, the high glucose levels in his blood cause polydipsia, insulin resistance, which prevents the body’s cells from absorbing glucose and causes a feeling of hunger, which can result in polyphagia. During Mike’s fundoscopy, it was discovered that he had diabetic retinopathy due to bilateral capillary microaneurysms with “dot and blot” haemorrhages. Microaneurysms, dot and blot haemorrhages can result from damaged small blood vessels in the retina caused by high blood sugar levels(Malhi et al.,2023).

The main cause of Mike’s T2D is insulin resistance, which is probably brought on by his sedentary lifestyle, which includes smoking, drinking too much alcohol, and making poor nutritional decisions. Mike should have SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) nursing goals. His glycemic control should be improved, his cardiovascular risk should be decreased, and complications should be avoided as the main objectives. Evidence-based nursing interventions should include patient education, dietary changes, medication administration, and routine follow-up(Mohsen et al.,2020).

Patient education on diabetes self-management, including medication adherence, blood glucose monitoring, good food, and physical activity, should be part of Mike’s nursing interventions. Focusing on quitting smoking, consuming less alcohol, and losing weight healthfully should be the main goals of lifestyle changes (Lockett, 2023). The effectiveness of interventions should be evaluated regularly so that they can be modified as necessary.

In conclusion, Mike’s example serves as a reminder of the significance of good diabetes care for avoiding complications and enhancing health outcomes. Healthcare professionals can assist patients like Mike in achieving improved glucose control and enhancing their general health and well-being by treating the underlying pathophysiology of type 2 diabetes and using evidence-based nursing care.

Nursing Process and Assessment Framework

A nursing process is a methodical approach nurses use to deliver patient care in a planned and systematic way. Assessment, diagnosis, planning, execution, and evaluation are the five primary steps in the process(Acevedo-Peñ et al.,2021). Based on the information and critical thinking, each stage is crucial in providing high-quality patient care.

Assessment is the first step in the nursing process. This entails gathering information regarding the patient’s current state of health, including their medical background, present symptoms, vital signs, and other pertinent data. A physical examination, laboratory tests, and interviews with the patient and their family may be part of the assessment(Meyer et al.,2021). For the nurse to accurately diagnose the patient and create a care plan tailored to the patient’s specific requirements, this stage aims to acquire as much information as possible about the patient.

The second phase is the diagnosis, which entails looking through the information gathered during the evaluation to find any current or possible health issues. The nurse applies critical thinking to the data analysis to spot potential patterns or linkages. The diagnostic, which describes how the patient responds to the health issue, is a nursing diagnosis rather than a medical one. The diagnosis aids the nurse in determining the patient’s requirements and creating a personalized treatment plan (Alexis Bradley and Lee W. Daffin Jr., 2018).

The third step, planning, is creating a care strategy considering the patient’s health issues. The care plan is unique to the patient and contains objectives and actions intended to help the patient meet those objectives(Coulter et al.,2015). In order to create a realistic and efficient strategy, the nurse considers the patient’s preferences and works with the patient, the patient, and other healthcare team members.

Implementation, the fourth step, entails carrying out the actions specified in the care plan. This may entail giving prescriptions, administering treatments, educating patients and their families, and coordinating care with other healthcare professionals. The nurse must record all interventions and assess how well they helped patients accomplish their objectives (Mozafaripour, 2023).

Evaluation is the last phase, and it entails evaluating the success of the interventions and altering the care plan as necessary. The nurse assesses the patient’s progress toward the objectives outlined in the care plan and decides whether any adjustments are required. The assessment is a continuous procedure requiring changing the patient’s care plan or referring them to other medical staff members (Paterson et al., 2022).

In managing patient care, the nursing process is essential. It offers a framework for nurses to deliver high-quality care in a planned and systematic way. Nurses can identify patients’ needs, create tailored care plans, and assess the success of their actions by using the nursing process. This guarantees that patients receive the greatest care and have the best results. Nurses use a structured nursing process approach to treat patients(Rouleau et al.,2017). Assessment, diagnosis, planning, execution, and evaluation are the five steps in the nursing process. Based on the information and critical thinking, each stage is crucial in providing high-quality patient care. The nursing process is essential for managing patient care and gives nurses a framework for providing high-quality care in a planned and systematic way.

Concerning Mike’s scenario, the best assessment framework is the Assessment of Daily Living. Activities of Daily Living (ADL’s) assessment framework assesses patients with long-term complex care needs. It, therefore, would be appropriate for Mike, a known type 2 DM patient(Roper, Logan and Tierney, 2023).

The activities of daily living (ADL) framework can be used to evaluate Mike’s present health status. His complaints of malaise and lethargy point to a potential decline in his energy and endurance, which could compromise his capacity to carry out ADLs like going up steep hills without getting out of breath. His reported polyphagia, polydipsia, polyuria, and dysuria point to a potential impairment in his capacity to maintain hydration and nutrition, which could limit his capacity to carry out ADLs, including preparing and eating meals with adequate hygiene. His reported change in vision and decreased feeling in his lower extremities indicate a potential impairment in his visual and sensory abilities, which could limit his capacity to carry out ADLs like driving and walking with balance. In order to assess his claimed dysuria and occurrences of penile thrush, further diagnostic techniques, such as a pain assessment test, may be required.

Nursing Problems

Following a thorough evaluation of Mike, two nursing issues have been determined. The top nursing concern is”Ineffective self-management related to poor knowledge of diabetes, unhealthy lifestyle practices, and noncompliance with diabetes medication regimen as evidenced by elevated blood glucose level, high HbA1c level, and presence of diabetic complications.” The second nursing concern is the “Risk for cardiovascular disease related to hypertension, dyslipidemia, central obesity, and unhealthy lifestyle practices as evidenced by elevated blood pressure, dyslipidemia, and central adiposity.”

Since Mike’s poor diabetes self-management has resulted in poor glycemic control and the emergence of diabetic complications, the first nursing issue is likewise a top priority. By teaching Mike about diabetes control, good lifestyle habits, and medication adherence, the nurse hopes to increase Mike’s self-management abilities. The precise objectives are lowering Mike’s HbA1c values to around 53 mmol/mol, accomplishing routine blood glucose monitoring, and promoting medication adherence.

The second nursing issue must be addressed because it seriously jeopardizes Mike’s health and well-being. Central obesity, dyslipidemia, and hypertension are significant risk factors for the emergence of cardiovascular disease(Barroso et al.,2017). Additionally, Mike’s risk for cardiovascular disease is increased by his bad lifestyle choices, which include smoking and drinking too much alcohol. By managing Mike’s hypertension, dyslipidemia, and central obesity through lifestyle changes, medication management, and routine blood pressure and lipid level monitoring, this nursing problem aims to lower Mike’s cardiovascular risk. The objectives are lowering Mike’s blood pressure to below 140/90 mmHg, lowering his LDL cholesterol levels to below two mmol/L, and achieving a waist circumference of less than 102 cm.

To protect Mike’s safety and stop the growth of chronic illnesses, the nursing issues identified for him need to be resolved right now. To direct nurse actions and assess their efficacy, each problem’s nursing goals should be SMART (specific, measurable, achievable, realistic, and time-bound). Mike’s general health and well-being can be improved by prioritizing and addressing these nursing issues.

Nursing Interventions Analysis

Inefficient self-management

Effective nursing interventions are essential in addressing nursing issues and achieving successful patient outcomes (Douglas et al.,2013). Several interventions can be used to manage the identified nursing problem of ineffective self-management related to inadequate diabetes knowledge, unhealthy lifestyle choices, and noncompliance with the diabetes medication regimen, as demonstrated by elevated blood glucose levels, high HbA1c levels, and the presence of diabetic complications.

The initial course of action is to educate the patient and his wife about diabetes, its consequences, the importance of adhering to a medication regimen, maintaining a healthy diet, getting regular exercise, and giving up smoking and alcohol. The patient’s understanding of the significance of following the recommended medication schedule and lifestyle changes to manage diabetes will be greatly aided by this intervention. Additionally, it aids the patient and his wife in comprehending the risks associated with diabetes and the value of routine follow-up visits. In order to increase patient comprehension and raise their level of health literacy, nurses might use instructional materials and visual aids.

The second intervention entails working with the diabetes specialist nurse and other medical professionals to create a personalized care plan for the patient based on their needs and preferences. This intervention entails creating a personalized care plan considering the patient’s unique needs and preferences. The patient’s socioeconomic situation, cultural background, and level of health literacy should all be taken into account while developing the care plan. It should also consider the patient’s current food and exercise routine and any medications they are currently taking. In order to create a complete care plan that considers all facets of the patient’s diabetes treatment, nurses can work in conjunction with the diabetes specialist nurse and other medical specialists (Morrissey, 2016).

The third intervention is routinely monitoring and documenting the patient’s weight, blood pressure, and symptoms to adjust the treatment strategy as needed. In order to obtain the best results, this intervention requires tracking the patient’s development and adapting the care plan as necessary. The patient’s weight, blood pressure, and symptoms can all be measured by nurses using a variety of instruments and methods, and the results can be entered into the patient’s medical file. Afterwards, they can adjust the care plan in light of the patient’s evolving needs (Wagner et al., 2017).

Encourage the patient to engage in self-care, self-management, self-monitoring activities, and regular follow-up appointments as the fourth intervention. With this strategy, the patient is encouraged to actively participate in managing their diabetes. Resources for self-care and self-management, including instructional materials, self-monitoring tools, and online support groups, can be given to patients by nurses. In order to track the patient’s progress and modify the care plan as needed, they can also encourage the patient to attend routine follow-up meetings (Ginsberg, 2019).

Nevertheless, the fifth intervention addresses the patient’s resistance to and facilitators of behaviour change by providing emotional support and motivational interviewing methods. This technique includes assisting the patient in removing obstacles to behaviour modification and encouraging optimistic views on diabetes self-management(Adu et al.,2018). To assist patients in identifying their reasons for changing their behaviour and creating a strategy, nurses can employ motivational interviewing approaches. In order to help the patient deal with the difficulties of treating diabetes, they can also provide emotional support.

Risk for cardiovascular disease

Patients have substantial concerns about the nursing issue of cardiovascular disease risk due to hypertension, dyslipidemia, central obesity, and bad lifestyle choices(Yu et al.,2016). By using nursing treatments that are patient-centred and evidence-based, the nurse can play a crucial role in addressing this nursing issue.

Working cooperatively with the patient’s primary care physician and other medical specialists to develop a personalized care plan based on the patient’s cardiovascular risk factors, preferences, and goals is the first intervention the nurse can carry out. Through dietary adjustments, medication adherence, and routine checkups, the patient’s hypertension, dyslipidemia, and central obesity should be managed as part of the care plan(Lee et al.,2019). The nurse’s participation in this intervention is vital because it can serve as the patient’s point of contact with the other medical specialists, ensuring that the treatment plan is realistic and personalized for the patient’s needs.

Teaching the patient and their spouse about cardiovascular disease, its risk factors, and the importance of lifestyle adjustments constitutes the second intervention. The significance of giving up smoking and drinking, eating a healthy diet, exercising frequently, controlling stress, and taking medications as directed should be emphasized in this teaching. The nurse can instruct the patient and their family using a variety of instructional tools, including booklets and films. The nurse can also give clear and succinct explanations to ensure that the patient understands the significance of lifestyle modifications and medication adherence in controlling their disease (Kwame & Petrucka, 2021).

The third intervention involves routinely monitoring and documenting the patient’s symptoms, lipid profile, waist size, and blood pressure. If necessary, the management plan is adjusted accordingly. The nurse should routinely check the patient’s condition should modify the care plan as necessary. With the aid of this intervention, the patient’s risk variables will be kept under good control, and any negative changes will be recognized quickly so that the proper steps can be taken.

As part of the fourth intervention, the patient is encouraged to do at least 150 minutes of organized exercise each week, such as walking, cycling, or swimming. Exercise is critical to managing cardiovascular disease, and nurses can play a significant role in motivating patients to exercise regularly(Sallis et al.,2015). The patient and the nurse can work together to create a personalized workout regimen that suits their needs and interests.

Finally, the nurse can use motivational interviewing techniques and emotional support to address the patient’s resistance to and facilitators of behaviour change. The patient will benefit from this intervention by gaining the drive and self-efficacy needed to achieve long-lasting lifestyle changes. The nurse can encourage the patient and boost their confidence in handling their condition by employing a variety of tactics such as goal-setting, feedback, and positive reinforcement.

Conclusion

The nurse can regularly assess Mike’s blood pressure, lipid profile, and waist size and document any changes to see if the patient’s cardiovascular risk factors are improving, stabilizing, or worsening. Mike’s adherence to medication, lifestyle changes, and exercise regimen is assessed, as this is essential to achieving the patient’s goals. Interventions like motivational interviewing and emotional support can be used to address the root causes if the patient is non-adherent. Thirdly, the nurse can assess the performance of the care strategy developed with input from the GP and other medical experts. The care plan should be adjusted as the patient’s risk factors and health status change.

According to the research, controlling cardiovascular risk factors includes routinely monitoring blood pressure, lipid profiles, and waist circumference (Schroeder et al., 2019). The risk of cardiovascular disease has also been demonstrated to be decreased by regular exercise (Pedersen et al., 2017). In patients with cardiovascular risk factors, motivational interviewing techniques have successfully encouraged lifestyle modifications (Pignataro et al., 2015).

Mike, a 56-year-old traffic officer, has a number of comorbid conditions and his type 2 diabetes is inadequately managed. Hyperglycemia and related problems are brought on by type 2 DM, which is characterized by insulin resistance, decreased insulin secretion, and increased hepatic glucose production. The best assessment criteria for Mike is the ADL assessment framework since he requires long-term care needs to ensure objectives are met. The nursing problems from Mike’s scenario include ineffective self-management and risk for cardiovascular disease. The goal after the elapse of 6 months is for the patient to exhibit adequate awareness of type 2 diabetes and reduce the risk for cardiovascular disease.

Numerous nursing interventions are needed to address inadequate diabetic self-management and cardiovascular disease risk. These interventions include educating patients, working with other medical professionals, scheduling routine checkups, monitoring and modifying care plans, providing emotional support, and using motivational interviewing techniques. In order to provide patients with high-quality treatment, the nurse’s role is crucial. By implementing these nursing actions, nurses may help patients live happier, healthier lives.

References

Acevedo-Peñ, M., Ostiguín-Meléndez, R.M., Cadena-Anguiano, J.L., Ibarra-Gonzalez, M.P., Hernández-Hernández, J.R., Villalobos-Molina, R. and Tapia-Pancardo, D.C., 2021. Problem-Based Learning in Situ Applied to Students in the Assessment of Nursing Process. Open Journal of Nursing, 11(5), pp.378-389.

Adu, M.D., Malabu, U.H., Malau-Aduli, A.E. and Malau-Aduli, B.S., 2018. Users’ preferences and design recommendations to promote mobile app engagement for diabetes self-management: multi-national perspectives. PLoS One, 13(12), p.e0208942.

Alexis Bridley and Lee W. Daffin Jr. (2018) Fundamentals of Psychological Disorders. Washington State University. Available at: https://opentext.wsu.edu/abnormal-psych/chapter/module-3-clinical-assessment-diagnosis-and-treatment/ (Accessed: April 18, 2023).

Barroso, T.A., Marins, L.B., Alves, R., Gonçalves, A.C.S., Barroso, S.G. and Rocha, G.D.S., 2017. Association of central obesity with the incidence of cardiovascular diseases and risk factors. International Journal of Cardiovascular Sciences, 30, pp.416-424.

Bottaro, A. (2021) What are the three P’s of diabetes?Verywell Health. Verywell Health. Available at: https://www.verywellhealth.com/three-ps-of-diabetes-5120529 (Accessed: April 18, 2023).

Coulter, A., Entwistle, V.A., Eccles, A., Ryan, S., Shepperd, S. and Perera, R., 2015. Personalized care planning for adults with chronic or long‐term health conditions. Cochrane Database of Systematic Reviews, (3).

Holland, K. and Jenkins, J. eds., 2019. Applying the Roper-Logan-Tierney Model in Practice-E-Book. Elsevier Health Sciences.

Douglas, M.K., Uhl Pierce, J., Rosenkoetter, M., Pacquiao, D. and Callister, L.C., 2013. Standards of practice for culturally competent nursing care: 2011 update. Standards of practice for culturally competent nursing care: 2011 Update, pp.34-64.

Ginsberg, B.H. (2019) “Tools of self-care: Self-monitoring of blood glucose and tele-health resources,” The Diabetes Textbook, pp. 429–450. Available at: https://doi.org/10.1007/978-3-030-11815-0_27.

Kwame, A. and Petrucka, P.M. (2021) A literature-based study of patient-centred care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward – BMC nursing, BioMed Central. BioMed Central. Available at: https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00684-2 (Accessed: April 18, 2023).

Lee, H.Y., Shin, J., Kim, G.H., Park, S., Ihm, S.H., Kim, H.C., Kim, K.I., Kim, J.H., Lee, J.H., Park, J.M. and Pyun, W.B., 2019. 2018 Korean Society of Hypertension Guidelines for the management of hypertension: Part II-diagnosis and treatment of hypertension. Clinical hypertension, 25, pp.1-24.

Lockett, E. (2023) Alcohol and weight: 8 ways drinking slows weight loss, Healthline. Healthline Media. Available at: https://www.healthline.com/health/alcohol-and-weight-loss (Accessed: April 18, 2023).

Malhi, A., Grewal, R. and Pannu, H.S., 2023. Detection and diabetic retinopathy grading using digital retinal images. International Journal of Intelligent Robotics and Applications, pp.1-33.

Meyer, A.N., Giardina, T.D., Khawaja, L. and Singh, H., 2021. Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions. Patient Education and Counseling, 104(11), pp.2606-2615.

Morrissey, D. (2016) “All patients deserve holistic care,” Nursing Standard, 30(49), pp. 34–34. Available at: https://doi.org/10.7748/ns.30.49.34.s44.

Mozafaripour, S. (2023) Nursing interventions and implementing patient care plans: USAHS, University of St. Augustine for Health Sciences. Available at: https://www.usa.edu/blog/nursing-interventions/ (Accessed: April 18, 2023).

Pedersen, B.K., 2017. Anti‐inflammatory effects of exercise: role in diabetes and cardiovascular disease. European journal of clinical investigation, 47(8), pp.600-611.

Paterson, C., Roberts, C. and Bail, K. (2022) “‘paper care not patient care’: Nurse and patient experiences of comprehensive risk assessment and Care Plan Documentation In Hospital,” Journal of Clinical Nursing, 32(3-4), pp. 523–538. Available at: https://doi.org/10.1111/jocn.16291.

Pignataro, R.M. and Huddleston, J., 2015. The use of motivational interviewing in physical therapy education and practice: empowering patients through effective self-management. Journal of Physical Therapy Education, 29(2), pp.62-71.

Roper, N., Logan, W.W. and Tierney, A.J., 2023. Das Roper–Logan–Tierney–Modell: Basierend auf Lebensaktivitäten (LA). Hogrefe AG.

Rouleau, G., Gagnon, M.P., Côté, J., Payne-Gagnon, J., Hudson, E. and Dubois, C.A., 2017. Impact of information and communication technologies on nursing care: results of an overview of systematic reviews. Journal of medical Internet research, 19(4), p.e122.

Sallis, R., Franklin, B., Joy, L., Ross, R., Sabgir, D. and Stone, J., 2015. Strategies for promoting physical activity in clinical practice. Progress in cardiovascular diseases, 57(4), pp.375-386.

Sanches, J.M., Zhao, L.N., Salehi, A., Wollheim, C.B. and Kaldis, P., 2023. Pathophysiology of type 2 diabetes and the impact of altered metabolic interorgan crosstalk. The FEBS Journal, 290(3), pp.620-648.

Schroeder, E.C., Franke, W.D., Sharp, R.L. and Lee, D.C., 2019. Comparative effectiveness of aerobic, resistance, and combined training on cardiovascular disease risk factors: A randomized controlled trial. PloS one, 14(1), p.e0210292.

Shewangizaw, Z. and Mersha, A., 2015. Determinants towards implementation of nursing process. American Journal of Nursing Science, 4(3), pp.45-49.

Wagner, C.S., Egan, B.M. and Li, J. (2017) “Controlling systolic blood pressure below 140 mm hg in most hypertensive patients matches systolic blood pressure intervention trial intensive treatment: Practical implications for patient care,” Hypertension Journal, 3(1), pp. 12–19. Available at: https://doi.org/10.5005/jp-journals-10043-0064.

Yu, E., Rimm, E., Qi, L., Rexrode, K., Albert, C.M., Sun, Q., Willett, W.C., Hu, F.B. and Manson, J.E., 2016. Diet, lifestyle, biomarkers, genetic factors, and risk of cardiovascular disease in the nurses’ health studies. American journal of public health, 106(9), pp.1616-1623.

Appendix

Name: Mike.

Date: April 18,2023.